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Is there a link between the use of benzodiazepines and related drugs and dementia? A systematic review of reviews

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Key summary points

AbstractSection Aim

To conduct a systematic review, appraise and summarise published synthesis studies on the association between the use of benzodiazepines (BZDs) and related drugs (BZRDs) and the risk of dementia development.

AbstractSection Findings

Data from this systematic review suggest an association between the use of BZDs/BZRDs and increased risk of cognitive decline and dementia in older adults.

AbstractSection Message

These findings propose caution when prescribing these drugs, avoiding or reducing their consumption to short periods, to decrease this risk.

Abstract

Purpose

Benzodiazepines (BZDs) and related drugs (BZRDs) are commonly used to treat diverse psychiatric disorders due to their anxiolytic, hypnotic and sedative properties, despite their known associated side effects, including acute consequences on cognition. Recently, some studies have also suggested that long-term cognitive effects may coexist, as the increased risk of cognitive decline and dementia. This review aims to appraise and summarise published synthesis studies on the risk of dementia development due to BZDs/BZRDs use.

Methods

A comprehensive systematic search was carried out in PubMed, Web of Science, Cochrane Library and Epistemonikos databases. Grey literature and hand search of the studies’ reference lists were undertaken. Meta-analysis, systematic and non-systematic reviews were included. Neither language nor date restrictions were applied. Search results other than synthesis studies were excluded. The methodological quality of the included reviews was analysed with AMSTAR-2 and SANRA tools.

Results

Overall, 877 records were initially retrieved and 15 complied with the inclusion criteria. From these, five were systematic reviews with meta-analysis, two were systematic reviews and eight were non-systematic reviews. Most of the primary studies included in the analysed reviews found an association between BZDs/BZRDs use and subsequent dementia, with meta-analysis studies reporting an increased risk for users (ORs ranging from 1.38 to 1.78). However, the considerable clinical and methodological heterogeneity of the primary studies makes it difficult to establish a causal relationship.

Conclusion

Although hampered by the heterogeneity between the studies, the present findings suggest an association between BZDs/BZRDs use and increased risk of dementia in older adults.

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Acknowledgements

The authors would like to thank the representatives of Janssen Medical Cloud for their assistance in obtaining the full-text of three studies.

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This research did not receive any funding or financial support.

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Porto, Portugal

    Patrícia Ferreira, Ana Rita Ferreira, Beatriz Barreto & Lia Fernandes

  2. Faculty of Medicine, CINTESIS–Center for Health Technology and Services Research, University of Porto, Porto, Portugal

    Ana Rita Ferreira & Lia Fernandes

  3. Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal

    Lia Fernandes

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  1. Patrícia Ferreira
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Contributions

PF, ARF and LF conceived and designed the study. PF designed the search strategy and performed the initial search. PF and BB screened and independently assessed the search results. ARF arbitrated disagreements during the review. PF drafted the first version of the manuscript and conducted the data analysis. LF and ARF supervised the work. All authors critically revised the manuscript and approved its final version.

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Correspondence to Patrícia Ferreira.

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Ferreira, P., Ferreira, A.R., Barreto, B. et al. Is there a link between the use of benzodiazepines and related drugs and dementia? A systematic review of reviews. Eur Geriatr Med 13, 19–32 (2022). https://doi.org/10.1007/s41999-021-00553-w

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